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Helsinki, Finland — Whole blood, once a cornerstone of emergency medical care, is undergoing a potential revival in civilian practice. A groundbreaking clinical trial in Finland, spearheaded by the Finnish Red Cross Blood Service, aims to determine whether whole blood can safely and effectively be used in prehospital settings to treat acute bleeding.
The study, running until the end of 2025, involves two air ambulances and one ground unit, with a focus on comparing whole blood to the more commonly used individual blood components. “Whole blood was used in Finland, like in many other countries, for decades,” said Dr. Jouni Lauronen, MD, PhD, the trial’s principal investigator. However, its civilian use in Europe largely disappeared by the early 1990s, replaced by transfusion of individual components such as plasma, red blood cells, and platelets.
A Historical and Practical Shift
First introduced during World War II, whole blood remains a staple in military conflicts, from Ukraine to the Middle East. Yet in civilian hospitals, it fell out of favor due to the logistical advantages of blood components. Components allow for targeted transfusion, longer shelf lives, and the ability to treat multiple patients from a single donation.
But this approach poses challenges, especially in prehospital environments like air ambulances. Red blood cells, plasma, and platelets each have unique storage requirements, and their administration in emergencies can be logistically complex. “It’s easier to transfuse one unit containing all elements of the blood you need,” said Professor Torunn Oveland Apelseth, MD, PhD, of Bergen Hospital Trust in Norway.
Norway reintroduced whole blood to its air ambulances in 2015 and expanded its use across hospitals by 2017, citing its simplicity and effectiveness in emergencies such as trauma and postpartum bleeding.
Why Consider Whole Blood Now?
Whole blood provides several advantages in emergency scenarios. It delivers a more concentrated dose of critical components, reducing the need for excess fluid. This can be crucial when time is of the essence, as in cases of hemorrhagic shock or severe trauma.
However, whole blood isn’t without risks. For example, using O-positive whole blood without testing for certain antibodies could lead to hemolysis, a potentially dangerous complication. Despite this, studies suggest that the benefits may outweigh the risks in specific settings, particularly when rapid transfusion is necessary.
International Efforts and Military Influence
The Finnish trial is part of a broader European interest in revisiting whole blood. The UK is conducting a multicenter trial across 10 air ambulance services, while France is exploring its use in hospitals, motivated by experiences during the 2015 Paris terrorist attacks. In these high-stakes situations, delays in delivering blood proved costly.
Military strategies also heavily influence these trials. “War-type casualties are clearly occurring in civilian settings,” noted French trialists, underscoring the growing need for rapid, effective blood transfusion methods in emergencies.
Challenges and the Path Forward
While the results of these trials may bring whole blood closer to civilian mainstream use, challenges remain. Trials like Finland’s are not randomized, which could introduce confounding variables. Cost and waste are also concerns; unused whole blood could strain donor supplies, potentially discouraging donations.
Despite these hurdles, countries like Norway, which have already implemented whole blood in hospitals and emergency services, report success. “Neither clinicians nor blood bank staff want to turn back,” said Apelseth.
The results of these trials could redefine transfusion practices worldwide. As Dr. Lauronen notes, the stakes are high: “Every second counts in prehospital settings. If whole blood can save lives, it’s worth exploring.”
